Understanding social disparities in hypertension prevalence, awareness, treatment, and control: The role of neighborhood context

Abstract

The spatial segregation of the U.S. population by socioeconomic position and especially raceethnicity suggests that the social contexts or "neighborhoods" in which people live may substantially contribute to social disparities in hypertension. The Chicago Community Adult Health Study did face-to-face interviews, including direct measurement of blood pressure, with a representative probability sample of adults in Chicago. These data were used to estimate socioeconomic and racialethnic disparities in the prevalence, awareness, treatment, and control of hypertension, and to analyze how these disparities are related to the areas in which people live. Hypertension was significantly negatively associated with neighborhood affluence/gentrification, and adjustments for context eliminated the highly significant disparity between blacks/African-Americans and whites, and reduced the significant educational disparity by 10-15% to borderline statistical significance. Awareness of hypertension was significantly higher in more disadvantaged neighborhoods and in places with higher concentrations of blacks (and lower concentrations of Hispanics and immigrants). Adjustment for context completely eliminated blacks' greater awareness, but slightly accentuated the lesser awareness of Hispanics and the greater levels of awareness among the less educated. There was no consistent evidence of either social disparities in or contextual associations with treatment of hypertension, given awareness. Among those on medication, blacks were only 40-50% as likely as whites to have their hypertension controlled, but context played little or no role in either the level of or disparities in control of hypertension. In sum, residential contexts potentially play a large role in accounting for racial-ethnic, and to a lesser degree, socioeconomic disparities in hypertension

Do socioeconomic disparities affect accessing and keeping antihypertensive drug therapy? Evidence from an Italian population-based study

“…Poor socioeconomic status has been found to be related to the lack of adherence in antihypertensive drugs in previous studies. 4,9,27,28 We did not find a clear relationship between income and risk of discontinuation. This suggests that the effect of income disparities in keeping with antihypertensive treatment might be mitigated from the universal coverage for drug treatment for hypertension supplied from the Italian NHS.…”

“…2,3 Socioeconomic factors, such as income, education and ethnicity, have been extensively investigated as possibly associated with the rate of treatment and control of hypertension. [4][5][6][7][8][9] However, data on this issue mainly reflect private, or mixed publicprivate, health care systems. Despite the fact that the Italian National Health Service (NHS) provides universal coverage for health care, including drug treatment for hypertension, socioeconomic disparities in the occurrence of coronary heart disease still persist.…”

Awareness, Treatment and Control of Hypertension Among Filipino Immigrants

“…15,18,20 Third, our screening survey did not include several important variables, including educational attainment, income, routine sources of health care, and knowledge regarding hypertension, which other studies have shown to be predictors of awareness, treatment, and control. 18,29,32,35,36 Finally, white coat hypertension could modify the prevalence of hypertension in the unaware group, since hypertension was defined using 1 day of BP readings. 2 Following recommendations, we took repeated measurements that were at least 3 min apart and used the last two out of three measurements to reduce the chance of wrongly detecting hypertension.…”

The Association of Minority Self-Rated Health with Black versus White Gentrification

“…[13][14][15][16] In spite of the potential ramifications that gentrification carries onto health, no study to date has sought to untangle the complex relationships between gentrification and health using this method. Through hierarchical modeling, we answer the question of how an individual's race/ethnicity moderates the effects of neighborhood gentrification on their health.…”